Bowel cancer screening works
AN editorial in the latest MJA says early positive results from the National Bowel Cancer Screening Program (NBCSP) should encourage the federal government to accelerate the implementation of the program and actively promote it to eligible population groups to boost participation. The editorial was commenting on a study in the same issue of the MJA that showed colorectal cancers (CRCs) were diagnosed at a significantly earlier stage in people invited to the NBCSP compared with those who were not invited, regardless of participation status or test result. The intention-to-screen analysis-based evaluation was based on 3481 eligible patients, of which 221 were invited to the NBCSP. It found those invited to participate were more likely to have stage A lesions compared with all other patients (34.8% versus 19.2%), and half as likely to have stage D CRC (5.4% versus 12.4%). The authors wrote that the shift towards earlier stage progressively increased in participants in the screening test and in those who were recorded as having positive results in the faecal immunochemical test. The NBCSP should lead to reductions in CRC mortality in Australia, they wrote.

Most cancer patients die in hospital
HOSPITAL remains the most common place of death for patients with cancer, although home and hospice deaths have increased since 2005, according to an English study published in PLOS Medicine. The research, which analysed the place of death of more than 2.2 million people who died of cancer between 1993 and 2010, found those who died from haematological cancer, and those who were single, widowed or divorced, and aged over 75 years were less likely to die at home or in a hospice. During the study period there was little change in the place of death for patients with lung cancer, with most of these patients dying in hospital. The researchers said the overall trend towards more deaths at home and in a hospice from 2005 coincided with the launch in 2004 of a national end-of-life care program in England, which was based on research evidence about patient preferences on place of death. The researchers said more efforts were needed to reduce hospital deaths. “Health care facilities should be improved and enhanced to support the increased home and hospice deaths. People who are single, widowed, or divorced should be a focus for end-of-life care improvement, along with known at risk groups such as haematological cancer, lung cancer, older age, and deprivation”, they wrote.

Maternal and neonatal risks rise with BMI
A LARGE retrospective study, published in the BJOG, of more than 30 000 singleton births over 8 years has found a significantly increased risk of adverse maternal and neonatal outcomes in women classified as overweight and obese according to their body mass index (BMI) and the WHO categorisation. Compared with women of normal weight (BMI 18.5 to <25 kg/m2), those who were overweight or obese class I (BMI 25 to <35 kg/m2) had a significantly increased risk of hypertensive disorders in pregnancy, gestational diabetes, induction of labour, caesarean section, postpartum haemorrhage and macrosomia, with the risk increasing further for women who were obese class II and III (BMI 35 kg/m2 and over). The most obese women were at increased risk of preterm delivery, stillbirth, postnatal stay of more than 5 days and an infant requiring admission to a neonatal unit. “These risks have obvious implications for the management of these women during their pregnancy, labour, and postnatal period”, the researchers wrote. “It is important when planning care for women who are overweight or obese that resources are allocated appropriately in order to minimise the risk factors for these women.”

Focus on linear growth in babies
INTERVENTIONS to increase birthweight and linear growth during the first 2 years of life in low to middle income countries were likely to result in substantial gains in height and schooling, and give some protection from development of adult chronic disease risk factors, according to research published in The Lancet. The researchers analysed five prospective birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa. They found the data support the present focus on promoting improved nutrition and linear growth in the first 1000 days of life, and also reinforced the importance of preventing rapid relative weight gain after 2 years of age. They recommended that growth monitoring programs incorporate length and height measures, not just weight measures. “New interventions that specifically promote linear growth instead of weight gain should be developed, tested, and promoted; exclusive breastfeeding, high-quality protein (eg, animal), and micronutrients could be further investigated”, the researchers wrote. An accompanying comment said the research had important implications for public health policy and nutrition interventions.

Cognition predicts dementia in Parkinson’s
MILD cognitive impairment (MCI) within the first year of Parkinson disease (PD) diagnosis signals a highly increased risk for early incident dementia, according to new research published in JAMA Neurology. The Norwegian population-based study of 182 patients with PD who were monitored for 3 years found more than 25% of patients with MCI at diagnosis of PD developed dementia within 3 years of follow-up compared with less than 1% of patients without MCI when diagnosed with PD. Among patients with MCI at baseline and 1 year of follow-up, almost half progressed to dementia. “These findings support the validity of the MCI concept in patients with early PD”, the researchers wrote. An accompanying editorial said cognitive impairment in PD was common and using uniform criteria for PD-MCI diagnosis was important to research, the prediction of dementia, and developing clinical trials to test therapeutic interventions.

Infectious link to cognitive decline
NEW research published in Neurology extends findings from previous studies showing infectious burden (IB) from common pathogens such as Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus and herpes simplex virus 1 and 2, is a risk factor for both stroke and cognitive impairment. Researchers used the 30-point Mini-Mental State Examination (MMSE) at enrolment and the modified Telephone Interview for Cognitive Status (TICS-m) at annual follow-up visits for a multi-ethnic cohort of 1625 stroke-free participants. The results for unadjusted analyses showed a higher IB index was associated with worse cognition and these effects were attenuated after adjusting for risk factors. The researchers wrote that, while their results needed to be validated in independent populations, treatment and eradication of common pathogens might have a positive impact on cognition as well as stroke. “In the case of viral pathogens, early childhood vaccination or antiviral treatment could decrease stroke risk and cognitive impairment. Based on our data, early intervention might be more promising, since there was no association with decline over time in this elderly cohort”, the researchers wrote. An accompanying editorial said it was hoped the latest research would stimulate further research in this area.

Posted 2 April 2013

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